Objectives During the 2019 Coronavirus disease (COVID-19) outbreak, malnutrition may contribute to COVID-19 adverse outcomes. We conducted a clinical epidemiological analysis to investigate the association of malnutrition with hospitalized duration in patients with COVID-19. Design Retrospective survey study. Setting Taikang Tongji (Wuhan) hospital in Wuhan, China. Participants 139 patients with COVID-19. Methods In total, 139 patients with COVID-19 from patients in the Infection Department of Taikang Tongji (Wuhan) hospital from February 2020 to April 2020 were analyzed retrospectively. We used the “Global leadership Initiative on Malnutrition(GLIM)” assessment standard published in 2019 to assess nutritional status. Prolonged hospitalization was lasting more than the median value of the hospitalized days (17 days) in this population. Results According to the assessment results of GLIM nutrition assessment, the patients were divided into malnutrition group and normal nutrition group. Compared with the patients in the normal nutrition group, the hospitalization time was longer(15.67±6.26 days versus 27.48±5.04 days, P = 0.001). Kaplan-Meier analysis showed patients with malnutrition were more likely to be hospitalized longer compared with those normal nutrition (mean with 95% confidence interval [CI]: 28.91[27.52–30.30] versus 22.78[21.76–23.79], P = 0.001). COX regression analysis showed that malnutrition (hazard ratio [HR] = 3.773, P for trend = 0.001) was proportional associated with being discharged from hospital delayed. Conclusion and implications Present findings suggested that malnutrition contributed to predicting a probability of prolonged hospitalization in patients with COVID-19 infection, to whom extra attentions and precautions should be paid during clinical treatments. Based on the existing results, it is recommended that inpatients with nutritional risk or malnutrition start nutritional support treatment as soon as possible.

Cardiac disease in patients with ankylosing spondylitis (AS) has previously been studied but not in patients with a kyphosis or in those who have undergone an operation to correct it. The aim of this study was to measure the post-operative changes in cardiac function of patients with an AS kyphosis after pedicle subtraction osteotomy (PSO). The original cohort consisted of 39 patients (33 men, six women). Of these, four patients (two men, two women) were lost to follow-up leaving 35 patients (31 men, four women) to study. The mean age of the remaining patients was 37.4 years (22.3 to 47.8) and their mean duration of AS was 17.0 years (4.6 to 26.4). Echocardiographic measurements, resting heart rate (RHR), physical function score (PFS), and full-length standing spinal radiographs were obtained before surgery and at the two-year follow-up. The mean pre-operative RHR was 80.2 bpm (60.6 to 112.3) which dropped to a mean of 73.7 bpm (60.7 to 90.6) at the two-year follow-up (p = 0.0000). Of 15 patients with normal ventricular function pre-operatively, two developed mild left ventricular diastolic dysfunction (LVDD) at the two-year follow-up. Of 20 patients with mild LVDD pre-operatively only five had this post-operatively. Overall, 15 patients had normal LV diastolic function before their operation and 28 patients had normal LV function at the two-year follow-up. The clinical improvement was 15 out of 20 (75.0%): cardiac function in patients with AS whose kyphosis was treated by PSO was significantly improved.

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BackgroundImaging modalities are essential for the diagnosis of ankylosing spondylitis (AS). Radiographic sacroiliitis is the requirement of 1984 modified New York (mNY) criteria for AS but with the disadvantage of low sensitivity. MRI has the advantage of detecting active inflammatory lesions but was criticized for low specificity. Computerized tomography (CT) has higher diagnostic accuracy than radiography in detecting structural changes, but its application has been limited for high radiation dose. The reduction of radiation dose can be achieved by decreasing the tube current[1] and previous study has demonstrated that effective dose (ED) of semi-coronal sacroiliac joint (SIJ) CT is at least six times lower in female or nearly four times lower in male than that of axial SIJ CT[2].ObjectivesTo evaluate the value of low-dose semi-coronal SIJ CT in the early diagnosis of AS.MethodsThirty-three patients diagnosed by mNY criteria who had pre-existing axial SIJ CT in past two years with visible structural damage were enrolled. These patients underwent low-dose semi-coronal SIJ CT examination which was obtained at 3-mm slices, 140 kV and 120 mAs, with the gantry tilted 20–25° cranially. The ED of the low-dose semi-coronal CT and the pre-existing conventional axial CT were compared. Image qualities of the low-dose semi-coronal CT were blind-graded separately by 2 rheumatologists into poor, fair, good or excellent. And the correlation between image quality and body mass index (BMI) was analyzed. The CT scans were read in a blinded manner by 2 rheumatologists who had been trained by radiologists. CT scans of the two groups were graded respectively by mNY criteria, the criteria established by Lee[3] and the Innsbruck criteria[4]. The kappa coefficient was used to assess the consistency of grading between the two groups.ResultsThirty-three patients received low-dose semi-coronal CT examination with an average ED of 3.37 mSv, which meant a 49% reduction in radiation compared to the pre-existing CT. The quality of images of male patients with BMI<25 kg/m2 and all female patients were good or excellent. Image qualities were assessed as poor or fair in 58% (7/12) male patients whose BMI>25 kg/m2. There was a significant negative correlation between image quality and BMI (r=-0.784,P=0.000). The grading of low-dose semi-coronal CT showed no differences as compared with the pre-existing CT by mNY criteria (see below). For the other two classification criteria, the consistency of grading between the two groups were satisfactory (kappa=0.897 by Lee criteria; kappa=0.814 by Innsbruck criteria; P>0.05).ConclusionsThe radiation dose of low-dose semi-coronal SIJ CT was reduced significantly compared with the conventional axial SIJ CT with acceptable diagnostic efficacy.ReferencesGurung J, et al. Multislice CT of the pelvis: dose reduction with regard to image quality using 16-row CT. Eur Radiol. 2005;15:1898–905.Jurik AG, et al. Effective radiation dose from semicoronal CT of the sacroiliac joints in comparison with axial CT and conven...